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DESCRIPTION
At birth, most babies are born head first with face down. In a breech presentation, the fetal buttocks or feet lie nearest the birth canal and are the first part to emerge. Breech presentation occurs in 3-4% of all births. Types of breech presentations include:
Frank breech where the thighs are flexed on the abdomen and both legs are extended at the knee so that the feet are near the head.
Complete breech where the thighs are flexed on the abdomen and both legs are flexed at the knee.
Footling breech where one or both legs are extended below the level of the buttocks.
Knee breech where one or both knees are extended below the level of the buttocks.
FREQUENT SIGNS & SYMPTOMS
There are no visible signs.
The diagnosis can be determined by abdominal palpation or vaginal examination and confirmed by ultrasound.
Fetal heart sounds are heard high on the mother's abdomen, usually around the belly button region.
CAUSES
Before 36 weeks, the fetus may move about from one position to the other. In the later weeks of pregnancy, these changes are more difficult. Usually the fetus spontaneously assumes the head down position, but in some instances the breech position occurs.
RISK INCREASES WITH
Premature labor and delivery.
Multiple fetuses.
Uterine abnormalities.
Fetal congenital malformation.
Pelvic tumor (fibroids).
PREVENTIVE MEASURES
None known to prevent the original breech position.
For some, a slanted board exercise where the mother lies with feet raised higher than her head for several minutes a few times a day. This exercise may be used in the latter part of pregnancy to attempt to naturally entice the fetus to change position to head down. This will only work if the fetus has not engaged into the pelvis.
For some others, after the breech position is diagnosed, a technique called external version is performed, which attempts to rotate the fetus to the proper position.
HELPFUL BREECH BIRTH LINKS
MyBreechBirth: Home Birth of a Footling Breech Baby
(Please note: I have removed this page due to certain individuals HOT LINKING to my photos and stealing my bandwidth.)
EXPECTED OUTCOME
The decision about delivery will be made on an individual basis. For some, a cesarean birth is recommended for breech babies, while in certain conditions, a vaginal delivery may be recommended. Discuss it fully with your health care provider or midwife.
In most cases, you and your baby will suffer no complications because of the breech presentation.
POSSIBLE COMPLICATIONS
Birth injury.
Compression of the umbilical cord causing lack of oxygen to the fetus.
Prolapse of the umbilical cord. Usual treatment for this would be a cesarean delivery.
TREATMENT
GENERAL MEASURES
Once the diagnosis of a breech presentation is made, be sure you are informed and understand the options and risks (both to you and to the fetus) involved for each type of delivery (cesarean or vaginal).
After Delivery:
- Showering is fine; delay tub baths for 2 to 3 weeks.
- Some degree of postpartum depression (crying jags and feelings of inadequacy) may occur which is normal after birth. However, some research has shown the quality of the birth experience and immediate bonding between mother and baby seems to play a significant factor in the level of "postpartum blues" that the woman may experience.
- Wear an external pad for the vaginal bleeding (lochia discharge) that will occur for several weeks. Your first menstrual period may return in 6 to 8 weeks, but may be delayed for several months if the mother is fully breastfeeding her infant.
MEDICATION
Prescription medication may be given for 2 to 7 days following the procedure.
You may use non-prescription medication, such as acetaminophen, for minor pain.
ACTIVITY
You may resume sexual relations after 2 weeks (although for some, 4 to 6 weeks may be recommended).
Return to normal activity as soon as your health and well being permit. This will occur more quickly following a vaginal delivery than it will with a cesarean delivery.
DIET
No special diet is usually necessary. However, if you are breastfeeding, continue with the same calorie and nutritional intake that you were eating during your pregnancy. Be sure to drink plenty of fluids to maintain your milk supply. See our Nutrition Information for obtaining and maintaining a healthy diet.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
If any of the following occurs prior to birth:
- New symptoms develop.
Any of the following occurs following the birth:
- Pain, swelling, redness, drainage or bleeding increases in the surgical area (cesarean or large episiotomy prior to forceps delivery in a medical facility).
- You develop signs of infection: headache, muscle aches, dizziness, or a general ill feeling and fever.
- Bleeding soaks more than one pad in an hour.
- The urge to urinate frequently persists longer than one month.
- Vaginal discharge persists beyond one month.
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LINKS
Graphics from Myles Textbook for Midwives, 8th Edition by Margaret F. Myles.
